Radical Robotic-Assisted Laparoscopic Prostatectomy: A Daycase Procedure

Dear Editor:

The length of stay in our unit has been reduced following the move from open to radical robotic-assisted laparoscopic prostatectomy (RALP) in 2008, from 4 days to 1.2 days. Anecdotally, many patients appeared to be well enough to be discharged on the same day.

It was shown that daycase laparoscopic prostatectomy is feasible by Roy et al. ¹ We therefore commissioned an audit to examine the need for medical intervention, within the first 24 hours following RALP, in order to ascertain its potential safety as a daycase procedure.

One hundred consecutive patients were identified. A standard six-port transperitoneal technique, using the da Vinci^® S robot system (Intuitive Surgical, Sunnyvale, CA), was used in all patients. All men were monitored overnight as per our standard protocol. All complications were classified according to the Clavien–Dindo system.^2,3 Any requirement for medical and nursing interventions was noted.

Of the 100 patients, only 1 patient required medical review by a doctor within the 24 hours following his surgery. A second patient developed a low-grade temperature that settled without medical treatment. These were Clavien Grade 1 or 2. On each occasion, the problems were noted within 4 hours of surgery.

These audit data suggest that RALP could be safely performed as a daycase procedure. We plan to develop this further within our department (Fig. 1).

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FIG. 1.

Protocol for daycase robotic-assisted laparoscopic prostatectomy (RALP). ASA, American Society for Anesthesiologists; BP, blood pressure; HR, heart rate; RR, respiratory rate.